If Bernard Madoff Were a Doctor

Dr. Kate Scannell compares disgraced financier Bernie Madoff to pharmaceutical shill, Scott S. Reuben, MD: 

In an analogous manner, the story of Dr. Scott S. Reuben tells the tale of one man who, in pursuit of personal gain, harmed huge segments of our nation’s health care system. That he could get away with falsifying pharmaceutical research and medical publications on such a massive scale over many years also tells a larger story about our nation’s medical research industrial complex. 

That complex — the enormous, poorly regulated, financially incestuous and opaque system that generates and disseminates the medical information we use to determine health care for patients — is similarly structured to allow individuals and privileged industries to profit through backroom deals. 

A few days ago, it was widely reported that Reuben, an anesthesiologist in Massachusetts and a faculty member of Tufts’ medical school, had falsified at least 21 of his 72 published research studies. He simply made them up. 

Many of those fictional studies promoted the use of painkillers — like Pfizer’s Celebrex or Merck’s Vioxx — during orthopedic surgeries, highlighting yet another layer of his disgrace. Those drugs, known collectively as “COX-2″ drugs, have been suspected of causing severe side effects like heart attacks and strokes, and Vioxx was finally withdrawn from the market in 2004. 

As was reported in Scientific American, Reuben’s work tried to encourage surgeons to abandon use of older and less expensive anti-inflammatory painkillers in favor of newer and more expensive ones called “COX-2″ drugs. 

In addition to faking research, downplaying COX-2 side effects, and jacking up the cost of medical care, Reuben also profited from financial arrangements with Merck and Pfizer. Those relationships are hard to confirm in his publications, but you find evidence of them in odd places. For example, in a conference brochure (Reuben lectured widely to disseminate his “research”) you discover that he not only received “grants” from Merck and Pfizer, but that he was also on their for-hire speaker’s bureau.  

The rest of Dr. Scannell’s commentary is found at Inside Bay Area.

1 Response to “If Bernard Madoff Were a Doctor”

  1. 1 Gerald Rogan, MD says

    Fabricating evidence is not new. The author of some of the studies that allege to show the benefit of hepatic activation for the treatment of brittle insulin dependent diabetes was disciplined by the FDA for fabricating evidence.

    Physicians must be critical of scientific evidence. For example, physicians cannot rely on the summary of a published article to accurately describe its findings. The conclusions of an article can be overstated, particularly when it uses terms such as “promising” and “likely to”. The term “significant” can be used to describe a concept in statistics or a clinical concept. Look for favorable arguments that are bolstered by defeating a “straw man” to make the product or service appear favorable. For cancer drugs, look for an overall survival benefit. A complete or partial response without an OS benefit means the images look good but the patient does not live longer: so the relevant question is the quality of life with and without the cancer treatment.

    I still do not understand the reason to prescribe anti-inflammatories v. recommending OTC anti-inflammatory products. If a patient has GI side effects, use the anti-inflammatory with food or milk, or check for H. Pylori before switching to a prescription anti-inflammatory. Remember, dispensing free samples is not an excuse to avoid OTC products.

    As for peer review, the California Business and Professions and Economic Development Committee held a hearing to gain more information about peer review in California. Although some peer review can be without justice, we have a greater problem of absent or ineffective peer review. The California Legislature will address all these problems in its pending legislation. Just like of experience with Wall Street’s lack of accountablity, protecting a “star performer” from peer review is a failed strategy. The concept of “trust but verify” comes to mind. Some of the information is available at http://www.roganconsulting.com.

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